Overtreatment


Matt Yglesias comments on an op-ed about the misuse of PSA screening for prostate cancer:

A kind of odd piece of conventional wisdom has hardened that it’s dishonest of Barack Obama or Matt Yglesias or anyone else to suggest that there are some free lunches to be had in the realm of health reform….[But] in the health care domain, in particular, a mix of weak science, bad economic incentives, and poor mathematical understanding leads to a fair amount of over-treatment. And over-treatment for cancer isn’t just an issue of spending money that didn’t need to be spent — treatment for prostate cancer normally has very unpleasant side effects and it’s really cruel to inflict it on men who don’t actually need the treatment. And as far as cancers go, that’s totally typical. Reducing over-screening and over-treatment would probably save money (though it’s always hard to know what the long-term impact will be since everyone eventually gets sick and dies) and will definitely spare patients a lot of pain and suffering.

True enough. The problem is that it’s not just doctors and pharmaceutical companies pushing these tests, though that’s part of it. It’s also patients who demand this stuff, and if you withhold it because “researchers” or “bureaucrats” say it’s not cost effective, they go nuts. And they’ll be goaded along in their hollering by whichever political party thinks it might gain them a momentary advantage.

I’m not sure what the answer is. Better patient education? I guess I’m not very hopeful about that. Economic incentives? Maybe, but when it comes to cancer that probably won’t do the trick either. More rigorous approval procedures for this stuff? Perhaps, though there’s an obvious tightrope to walk in order to get this right.

In any case, this is one of those topics that I have a hard time figuring out because my own temperament is so obviously different from most people’s. I don’t really like seeing doctors, I prefer the lightest treatment possible, and I dislike trying anything that hasn’t been around for at least a decade or two. But most people just aren’t wired this way. They see their doctor at the first sign of trouble, demand as much attention as they can get, and insist on whatever the latest and greatest treatments are. I just don’t get this. But it’s the reality, and the cure — pardon the pun — is hard to figure out.

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